Systems of Psychotherapy: A Transtheoretical Analysis

1. Systems of Psychotherapy: A Transtheoretical Analysis Chapter 6. Experiential Therapies

2. A Sketch of Fritz Perls ♦ 1893 - 1970 ♦ Received MD in Berlin ♦ Studied at the Vienna Institute of Psychoanalysis & analyzed by Wilhelm Reich ♦ Established New York Institute for Gestalt ♦ Difficult to separate Fritz from Gestalt techniques ♦ Built Gestalt Center in British Columbia in 1970 & soon after died

3. Theory of Personality ♦ End-goals, based on biological needs, are experienced as pressing until they are completed ♦ Humans spend inordinate energy pursuing social means as end-goals ♦ Maturation entails realizing others do not exist to serve you & you do not exist to serve them ♦ Childhood experiences can limit maturation ♦ Mature people discover new means of achieving end-goals

4. Theory of Psychopathology ♦ Disruption of maturation can cause 5 levels of pathology: phony, phobic, impasse, implosive, & explosive ♦ Maya is phony level created to protect us from threatening aspects of our selves or world ♦ Unhealthy people refuse to accept they have attributes of both poles & lose their ability to flow through emotions ♦ Top Dog: our conscience insists on always being right and attempts to be master by commanding ♦ Under Dog: Slavish part of us, goes along with bullying of Top Dog, controls through passive resistance

5. 5 Levels of Psychopathology Phony Level: Attempt to live up to self-imposed ideals of self Phobic Level: Avoidance of pain caused by not living up to self ideals Impasse Level: Most critical level; realization of change & death of old self Implosive Level: Dealing with death of problematic parts of self Explosive Level: Extreme release of energy that maintained neurosis

6. Therapeutic Processes ♦ Consciousness raising regarding phony games & roles; liberation from maya ♦ Cathartic explosion of breaking out of neurosis (obtained after consciousness raising) ♦ Therapists show confidence in client by pressing ahead when client doubts own ability ♦ Therapists cannot let client shift responsibility for progress

7. Therapeutic Content Intrapersonal Conflicts ♦Anxieties & defenses ♦Self-esteem ♦Responsibility Interpersonal Conflicts ♦Intimacy & sexuality ♦Communication ♦Hostility ♦Control

8. Therapeutic Content (cont.) Indivduo-Social Conflicts ♦ Adjustment versus transcendence ♦ Impulse control Beyond Conflict to Fulfillment ♦ Meaning of life ♦ Ideal individual

9. Therapeutic Relationship ♦ Must be a genuine encounter with accurate empathy, I-Thou relationship ♦ Client’s immaturity receives negative feedback (not unconditional regard) ♦ Therapist blocks own urges to take control of client’s life ♦ Client’s responsibility to take hot seat ♦ Prompt client to produce, not just talk about, a new self

10. Practicalities of Gestalt Therapy ♦ One year of training at Gestalt training institute or university program ♦ Therapists are more informal about patient screening & outcome follow-ups ♦ Therapy length can vary from one workshop to weekly sessions for 6 months ♦ Briefer Gestalt therapy is the trend, with active and directive techniques

11. Experiential Therapies ♦ Class of psych treatments in humanistic tradition ♦ Central axis of change is experiencing ♦ Felt sense requires clients slow down, develop bodily awareness, and experience their lives differently ♦ Personality understood in terms of potentials for inner experiencing ♦ Many variants, but most popular and researched is emotion-focused (EFT)

12. Emotion-Focused Therapy ♦ Leslie Greenberg (1945 - ♦ Originally known as process-experiential ♦ Change emotions with emotions ♦ Respond to client markers - Two-chair work for splits - Evocative unfolding/empathy for uncertainty - Empty-chair dialogue for unfinished business ♦ Combines client-centered & Gestalt )

13. EF Couples Therapy ♦ Constructs healing emotional experience and attachment for couple ♦ Emphasizes two client capacities: Attachment bond, emotions ♦ Goal: help couples become increasingly aware of negative interactions and overcome them by establishing secure attachments

14. Effectiveness of Emotion-Focused Therapy ♦ Better than no treatment & placebo ♦ Randomized clinical trials (RCT) show - EFT more effective than person-centered for depression - EFT equally effective as cognitive-behavioral for depression ♦ Addition of emotion-focused to Rogerian therapy improves outcome

15. Effectiveness of EFT Couples Therapy ♦ More effective than no treatment & control groups ♦ 70% - 73% recovery for marital distress ♦ Recognized as evidence-based treatment for couples distress

16. Effectiveness of Gestalt ♦ Meta analysis of 18 studies found average effect size, higher than placebo ♦ Gestalt therapy showed slightly lower gains than other therapies in direct comparisons ♦ Gestalt not found superior to any other therapy but more effective than no treatment ♦ Some studies that found Gestalt inferior to other txs might be due to allegiance effect

17. Criticisms of Gestalt Therapy ♦ From a Cognitive-Behavioral Perspective (reinforces narcissism, lack of controlled research, higher risk for negative effects) ♦ From a Psychoanalytic Perspective (id overtakes ego, dangerous for certain clients) ♦ From a Cultural Perspective (little attention to relationships and culture, victim blaming of oppressed) ♦ From an Integrative Perspective (values body over mind, lacks cognitive theory)

18. Future Directions ♦ Continued influence on therapy integration, couples work, & specific client presentations ♦ Seeks other txs, such as psychodynamic, cognitive, & systemic, to balance & complete ♦ Trend away from uniform treatment of all clients ♦ Specifically supported for couples & depression

19. Key Terms affect regulation allegiance effect catastrophic expectations contact corrective emotional experiencing deflectors dramatic relief emotion-focused therapy emotionally focused couples therapy empty chair end-goals experiencing experiential therapy explosive layer focusing frustration Gestalt dream work Gestalts here and now hot seat “I take responsibility” impasse

20. Key Terms (cont.) implosive layer introjectors layers of psychopathology “May I feed you a sentence?” maya organismic needs own the projection phobic layer phony layer playing the projection Polarities present-centered process diagnosis Projectors psychodrama rehearsals repetition or exaggeration retroflectors reversals safe emergency sensate focusing Top Dog-Under Dog two-chair work/method unfinished business

21. Recommended Websites ♦ Association for the Advancement of Gestalt Therapy: www.aagt.org/ ♦ International Centre for Excellence in Emotionally Focused Therapy: www.iceeft.com ♦ Focusing Institute (Gendlin): www.focusing.org/ ♦ Gestalt Therapy Page: www.gestalt.org/ ♦ World Association for Person-Centered and Experiential Psychotherapy: www.pce-world.org/